Monday, December 27, 2004

Relying on the Kindness of Strangers


December 27, 2004

Hey, buddy. Are you still relying on the kindness of strangers? Do you still recommend to library patrons that they rely on the kindness of strangers? Do you still make that recommendation?

I can only thank my lucky stars -- and the planets held in their orbits by the force of attraction varying inversely with the square of their distance from the sun -- I can only thank my lucky stars (and my planets, for that matter) that you and I are, in reality, not friends, but fundamentally abject strangers. I can be sure of always being able to rely on your kindness. But more! Sometimes I consider myself to be the luckiest man in the world. I have no friends, none at all. Of the more than six billion people in the world, all are strangers to me. But imagine what that means! I have more than six billion people -- six billion strangers -- on whose kindness I can rely. I am truly blessed.

You must remember this, buddy:

"You want to use the computer for just a few minutes? Well, you'll have to wait in line. There's a queue. You have to log on to the queue line and wait your turn. But what you can do is ask Mr. Freedman -- that's Mr. Freedman on that computer, there -- what you can do is ask Mr. Freedman if he'd be willing to give up some of his time -- (his valuable time, for which he waited an hour or so to get) -- maybe Mr. Freedman would let you use some of his (precious) computer time to let you (bypass the rules and) get in to use the computer. Sometimes you have to rely on the kindness of strangers." Ah, yes, Brian, spoken like a true Christian. Verily, verily, you do your religion proud. Advising strangers to rely on my kindness. I can't count how many times I've relied on your kindness and have been richly rewarded. "Sometimes you have to rely on the kindness of strangers." What is that line from the New Testament? "For I so loved the library and its patrons that I was willing to sacrifice my only-begotten computer time to redeem the exigencies of a needy patron who was a stranger to me." Well, I'm nothing if not Godlike. The Christian God, of course: all charity and kindness. Yes, I have a Christian heart. I love my fellow man, and show it every day, like the true Christian I am. By the way, Brian, how did you enjoy that CD of the Beethoven "Missa Solemnis" that I gave you? I have to say, I, for my part, really enjoyed the T-shirt you gave me last year. It's the nicest thing a librarian has ever done for me. Your gift of that T-shirt was a heartfelt gesture of Christian charity. But then, you're a Christian; you do nice things every day of the week.

Or am I being sarcastic, and mordantly so?

Be that as it may.

How was your twenty-fifth? Did you spend it at rest or in motion? I, for one, continued in a state of rest; fortunately I was not compelled to change that state by forces imposed upon me.

I spent the day, like a solitary boy at the Lido in Venice, contemplating those few objects that sparked my interest, while, at the same time, ignoring the wealth of buildings, artifacts, and persons just across the lagoon. Like Isaac Newton, "I do not know what I may appear to the world, but to myself I seem to have been only like a boy playing on the seashore, and diverting myself in now and then finding a smoother pebble or a prettier shell than ordinary, while the great ocean of truth lay undiscovered before me."

The twenty-fifth! How I wait all year for that blissful day. Joyful memories of childhood pleasures -- the fantasies of unbounded gaiety -- reawaken in me, and for a few hours, at least, I feel alive. A-L-I-V-E! We -- the members of the Royal Society -- give thanks for this day, the day that commemorates the birth of a child who, by his example, showed the world that the sins of an indolent youth might be redeemed by the dedicated labors of the mature man. Did you know that the object of our annual celebration did not do well in grade school? He was reported as "idle" and "inattentive," neglecting prescribed studies for subjects that appealed to him, and giving much time to mechanical contrivances like sundials, water wheels, and homemade clocks. He skimped his studies to read books of his own choosing.

I speak of course of Sir Isaac Newton, whose birth we celebrate on December 25th.

How did I spend the day? Well, I can tell you I didn't spend the day with strangers -- or friends.

With my hands clasped in my lap I let my eyes swim in the wideness of an imagined watery expanse, my gaze losing focus, blurring, and growing vague in the misty immensity of a sea of fantasy. My love of the ocean, like my love of fantasy, has profound sources: the hard-worked artist's longing for rest, my yearning to seek refuge from the thronging manifold shapes of the real world in the bosom of the simple and vast; and another yearning, opposed to my art and perhaps for that very reason a lure, for the unorganized, the immeasurable, the eternal -- in short, for nothingness. Nothingness, in the truly Seinfeldian sense. He whose preoccupation is with excellence longs fervently to find rest in perfection; and is not nothingness a form of perfection? My December 25th was a day of Nothingness and Nothing, as vast as the unbounded universe.

I am a solitary, Brian. A solitary, who is unused to speaking of what he sees and feels, has mental experiences which are at once more intense and less articulate than those of a gregarious man. They are sluggish, yet more wayward, and never without a melancholy tinge. Sights and impressions which others brush aside with a glance, a light comment, a smile, occupy him more than their due; trivial events sink silently in, they take on meaning -- (generally negative; yes, I attribute a negative meaning to trivial events) -- they become experience, emotion, adventure. Solitude gives birth to the original in us, to beauty unfamiliar and perilous -- to poetry. But also, it gives birth to the opposite: to the perverse, the illicit, the absurd, and the disquieting. Sir Isaac Newton, himself a solitary, was moody, sometimes irritable, suspicious, secretive, always timid though proud. He loved privacy, and did not make friends readily. Then, of course, Sir Isaac didn't speak Hebrew, he didn't eat out, and he didn't attend his local synagogue. He never married. High-strung and morbidly sensitive, he bore criticism painfully, resented it sharply, and fought back stoutly in controversy. Sound familiar, buddy?

We, the members of the Royal Society, salute you, Sir Isaac Newton: a solitary whose birth we solitaries celebrate each year on December 25th, if not in mirth, then at least -- in Solitude.

Did you know that modern psychiatry, based on the historical record, has diagnosed Isaac Newton, in retrospect, as schizoid -- that is, a solitary, unaffected by the affective ties that surrounded him: affective ties that bind the normal members of the human community into a universe of brothers?

I too am schizoid, at least according to The Mad Monk: a lone recreant, wandering aimlessly in random motion, impervious to the affective ties of my fellows. Will I ever escape the internal forces that compel my morbid isolation?

According to Dr. Bash, my personality deficits can be addressed by "cognitive therapy." As far as I can see, however, cognitive therapy, as practiced by Dr. Bash, comprises the procedure of her repeating week after week the same recommendations ad nauseam, and denying the legitimacy of all of my opinions, feelings, thoughts, ideas, recollections, and inferences about myself and my environment.

Like any authoritarian ideologue, Dr. Bash imposes her overbearing order in the name of a higher aim: in my case, therapeutic change. Ironically, and disturbingly, Dr. Bash's interaction with me -- specifically, its intrusively-overbearing and identity-disconfirming character -- has been cited as the very cause of schizoid withdrawal, which is seen developmentally, in part, as a defense against the fear of engulfment by unempathic attachment objects. Mind you, in the words of Sir Isaac Newton: "To every action there is always opposed an equal reaction" and, as Sir Isaac might have added, "not necessarily a salutary one."

I don't care if Dr. Bash doesn't help me. I fear that she is making my condition worse!

I believe that Dr. Bash uses her therapeutic approach as a rationalization to issue commands (what she calls recommendations) and deny the patient's individual identity. I believe that in the case of Dr. Bash there is no clear distinction between simple authoritarianism and what Dr. Bash terms "cognitive therapy" (which, as practiced by Dr. Bash, seems to be a cure that assigns to the therapist the role of sole judge of the real, the correct, and the appropriate).

With Dr. Bash I feel I cannot make my voice heard, and exercise some power over the conduct and content of my sessions, as if Dr. Bash needs to maintain her posture of power and omniscience. I discovered early on that I could not exert any influence during the sessions or make her take notice of my wants and opinions. In turn, I feel I can only retain autonomy if I repudiate her totally and withdraw into isolation. I cannot imagine that I can exert any influence over the thoughts or behavior of Dr. Bash, whom I think of as being both more powerful and more ruthless than myself. I think of Dr. Bash as being so entirely oblivious of my needs and wishes that I might as well not exist, and so every week I come to feel that my very being is threatened.

I can't see that Dr. Bash makes any distinction between, on the one hand, a person who is socially isolated but has the psychological ability to form relationships, and, on the other, a person who has distinct deficits that impair his ability to form social attachments. A person who suffers from schizoid personality disorder is not simply socially isolated. He has a distinct psychiatric syndrome -- an intrapsychic disturbance -- which impairs his ability to form relationships. Dr. Bash's weekly recommendation (repeated to the point of coercion) is: "Go to the synagogue, go to the synagogue. [Rely on the kindness of strangers!] You didn't go to the synagogue. If you went to the synagogue, you would meet people and make friends." -- "Isn't there anything we can do here, Dr. Bash, to help me?" -- "Your problem is you want everything on a silver platter. You want me to do everything. (Read: "I take responsibility for nothing.") As I see it, Dr. Bash's recommendation that I go to the synagogue to make friends has all the value of telling an illiterate person to go to his local library. "Go to the library. Place yourself among literate people. Eventually, you'll learn how to read." The schizoid (like the illiterate) has distinct problems that can be addressed only in the context of a specialized relationship that is dedicated to the remediation of specific deficits.

My social isolation is a single symptom or effect of a total, disturbed personality. The psychologist Drew Weston has some pertinent comments about the therapeutic limitations of addressing a single symptom of a disordered personality. Weston specifically addresses the treatment of eating disorders, but his comments are related to the problem of my social isolation, which must be seen as a symptom in the context of a disordered personality. "[S]ymptom-focused treatment strategies may fail to address the personality structure that provides a context for understanding disordered eating [or, in my case, social isolation]. Patients whose personality profiles match the overcontrolled, constricted prototype, for example, rarely recognize their stance toward their own impulses and relationships as a problem. What brings them into treatment is typically someone else's concern about their weight. If their attitudes toward their needs and feelings in general (and not just toward food [or, in my case, social relations]) do not become the object of therapeutic attention, they are likely to change with treatment from being starving, unhappy, isolated, and emotionally constricted people to being relatively well fed, unhappy, isolated, and emotionally constricted people." Weston, D., Harnden-Fischer, J., "Personality Profiles in Eating Disorders: Rethinking the Distinction Between Axis I and Axis II." Am. J. Psychiatry, 158(4): 547-562 at 560 (April 2001).

In any event, as you can plainly see, I've been engaged in a forbidden activity over the holidays. Yes, I admit it. I have violated one of Dr. Bash's "Thou Shalt Nots." I have been reading technical material! In addition to perusing The American Journal of Psychiatry, I have been reading "The Art of Psychotherapy," a book by the late British psychiatrist Anthony Storr. But, heck, it's the holidays. Why not throw caution to the wind for a couple of days? I'll live dangerously and read technical material if I want to. "Oy, to be a goy at Christmas," as Drew Weston likes to say.

Of course, according to The Mad Monk, I don't have the intellectual ability to understand technical material. So instead of paraphrasing what I've read, I'll reproduce a few pages of the chapter titled, "The Schizoid Personality" (with a few interpolations of my own).

So what does Dr. Storr say?

The schizoid is a deeply disturbed type of person whose fear of involvement with others is so extreme that he withdraws into himself and attempts to do without human relationships as far as possible. Schizoid people come to the attention of psychotherapists in a variety of ways. Because they have little faith in the ability of others to understand or help them, they are often pressed into seeking help by those who are near enough to them to realize that there is something wrong.
(cf. "What brings them into treatment is typically someone else's concern about their weight." Weston, D., Harnden-Fischer, J., "Personality Profiles in Eating Disorders: Rethinking the Distinction Between Axis I and Axis II." Am. J. Psychiatry, 158(4): 547-562 at 560. Both the schizoid and the anorexic suffer from "a dissociated lack of awareness of needs.") Thus, to take a characteristic example, an undergraduate who is failing at his work and who shows no signs of being able to make friends or enjoy university life may be steered into psychotherapy by a tutor. This will constitute an additional difficulty in therapy, though not necessarily an insurmountable one. If self-referred, such a patient will complain of not being able to make relationships, especially with the opposite sex; or of being quite unable to concentrate on work or complete work; or of what he is likely to call depression.

Although schizoid patients do indeed become depressed, their mood is often more of apathy than melancholia. As Fairbairn has aptly observed, "the characteristic affect of the schizoid state is undoubtedly a sense of futility." Although schizoid people may at first sight resemble depressed patients, one quickly comes to realize that their kind of depression has a quality of meaninglessness which is not present in the ordinary cases of depression. Depressives, one feels, are suffering from an interruption or bad episode in their lives; and their resentment can be felt just below the surface. With schizoid people, one feels that their mood of futility is much more integral to their ordinary adaptation; almost as if their lives never had had much meaning.

Dr. Bash, you will observe, refuses to recognize my sense of futility. She denies that my concerns about feelings of futility have any meaning (thereby contributing to my existing sense of meaninglessness.) "Go to the synagogue," she says. "Why don't you go? [Why don't you rely on the kindness of strangers?]" I say, "It's not going to do anything. I don't like most people. It's just futile. I don't connect with people. I don't make friends." The "sense of futility" is a distinct affective state that is recognized to predominate in the schizoid. For Dr. Bash the all-important "affective state" of futility has no "meaning," so that, in the end, she denies my feelings, thereby replicating my early pathogenic experience: namely, my interaction with an unempathic caretaker.

Schizoid people are often difficult to interview. The therapist feels that he is not on the same wavelength. When trying to take a history, he is likely to feel that, although the patient may be superficially cooperative in answering questions, he doesn't really give anything.. The patient may induce in the interviewer the feeling that, in answer to every query, he is really wanting to say: "What on earth is the point of asking me that?" Some schizoid patients appear to affect an air of superiority, especially if, as is not infrequent, they are intellectually superior, and have made their chief adaptation to the world by means of their brains rather than their feelings. It is important not to allow oneself to be put off by this. Therapists like to have their efforts appreciated, and it is disconcerting to be faced with an individual who appears to repudiate every attempt to get to know and understand him.

It is important to realize that patients of this kind are deeply frightened of any kind of intimacy. Their defense is to withdraw as far as possible from emotional involvement. But since it is emotional involvement which gives meaning to life, they are constantly threatened with finding life meaningless. If the therapist is sufficiently mature to tolerate being repudiated and made to feel useless by such patients, he will find them of great interest, and, if he manages to penetrate their defenses, will find himself richly rewarded by winning the trust of someone who for years has found it difficult to trust any other human being.

Why are persons of this kind so reluctant to allow anyone to become close to them? There seem to me to be three main types of fear of intimacy. All three may be present together; but one type is often more manifest than the others. First, a person may be reluctant to embark upon a relationship because he fears that it will end, and that he will therefore be worse off than if he had never taken the risk of involvement. This fear is often based upon an actual experience of loss in early childhood. Isaac Newton, for example, showed many schizoid traits of character. He was notably isolated, and never made any close emotional relationships with anyone of either sex. He was also extremely suspicious, reluctant to publish his work, and prone to accuse others of having stolen his discoveries. When he was just over fifty, he had a psychotic breakdown in which paranoid ideas were prominent. At least some of his emotional difficulties may reasonably be assumed to have taken origin from the experience of his early childhood. Newton was a premature child whose father had died before he was born. For the first three years of his life, he enjoyed the undivided attention of his mother. Then, when he was just past his third birthday, his mother remarried. She not only presented Newton with an unwanted stepfather, but added insult to injury by abandoning him, leading him to be brought up by his maternal grandmother whilst she herself moved to live in a different house with her new husband. We know from his own writings that Newton felt this to be a betrayal. He seemed never entirely to have trusted any human being again.

Dr. Bash denies that I experienced emotional loss in childhood. First, a patient cannot work through past losses if they are denied by the therapist. Second, the intrapsychic structural consequences of loss will not be remediated by real social attachments in adulthood. Again, the schizoid is struggling with the structural consequences of past experience; he is not struggling simply with social isolation in the present. A schizoid person is not a generic, socially-isolated person.

Additionally, Dr. Bash's lack of values and her lack of strongly-held convictions, as revealed in the gross contradictions of her comments from week to week, undermine her credibility and, most importantly, vitiate any sense of trust I might place in her statements. During the pendency of the ban on my library visits (April to October 2004) I suggested that I might leave you, Brian, a telephone message. Dr. Bash said: "NO! Don't do that! Brian doesn't want to have anything to do with you. Why do you think he called the police? The ban on visits to the library means a ban on any contact with Brian. It means no letters, no telephone calls, no contact of any kind. If you telephone Brian, Brian could call the police on you." Quite emphatic, don't you think? At my last session with Dr. Bash on Wednesday December 22, 2004, Dr. Bash said, thrusting her hand into the past: "You know, you probably could have gone back to the library after three months. You didn't have to wait until the entire six months had passed. If you had gone back after three months, what would have happened is that Brian would have seen you and he would have thought, 'My, has six months passed already?' He would have forgotten that you were not supposed to return to the library until October."

Dr. Bash's contradictory, self-serving statements merit comparison with the capricious edicts of Big Brother in Orwell's novel "1984." "All history was a palimpsest, scraped clean and reinscribed exactly as often as was necessary." "If the Party could thrust its hand into the past and say of this or that event, it never happened [or that the event had no meaning] -- that was more terrifying than mere torture and death."

How can I trust Dr. Bash? How can I see Dr. Bash as anything other than a shallow individual who will say anything at any time to further her own aims. Indeed, one of Dr. Bash's recent recommendations shows a striking disregard for my legal rights and all that implies about her respect for me as a patient. "Don't tell an employer you are disabled," she said. "You don't have to tell an employer that. If you don't tell him you're disabled he won't know." The fact is that, legally, if I do not tell an employer I am disabled I cannot invoke my legal rights as a disabled person. Dr. Bash's recommendation may, in fact, constitute an unlawful act of discrimination by a state employee; Dr. Bash, an employee of the District of Columbia, is recommending that a disabled person refrain from taking the necessary steps to allow him to invoke his legal rights. Does my interaction with Dr. Bash enhance my ability to trust others? To the contrary, my experience with The Mad Monk confirms that I can trust no one.

According to Dr. Storr a second reason for avoiding intimacy is the fear of being dominated and overborne by the other person to the point of losing identity as a separate individual. We all begin life being at the mercy of adults who [like Orwell's Big Brother] are much more powerful than we are, and we all strive, in varying ways, to reach a degree of independence. Although some people wish to continue to be subject to the authority of others, and to have many of the decisions of life made for them, even the most masochistic prefer to retain some autonomy. This can be detected in very small children, and many children's games are concerned with demonstrating that they can put down adults and be "king of the castle." As children grow up, most learn that they can make their voices heard, and exercise some power over events, even whilst they are with people who are more powerful than themselves. They discover that, although they may not be able entirely to have their own way, they can exert influence and make others take notice of their wants and opinions. The people we call schizoid, on the contrary conceive that they can only retain autonomy if they withdraw into isolation. They do not imagine that they can exert any influence over the thoughts or behavior of others, whom they think of as being both more powerful and more ruthless than themselves. They think of other people as being so entirely oblivious of their needs and wishes that they might as well not exist, and so come to feel their very being is threatened. R.D. Laing gives a good example of this in his book "The Divided Self." One patient is arguing with another in the course of a session in an analytic group. One breaks off to say: "I can't go on. You are arguing in order to have the pleasure of triumphing over me. At best you win an argument. At worst you lose an argument. I am arguing in order to preserve my existence."

Although at first sight such a statement might seem delusional, there may be more in it literally than meets the eye. Bruno Bettelheim, the psychoanalyst who was for a year confined in Dachau and Buchenwald concentration camps, observed that those prisoners who surrendered autonomy entirely and acquiesced in letting the guards determine their whole existence become like automata -- Mussulmen, as they were called -- and soon actually died. Survival seemed to depend upon preserving some tiny area in which decision could still be in the hands of the prisoner himself.

The fear of being overborne or engulfed, as Laing calls it, sometimes seems to be the consequence of having been treated with particular lack of consideration as a child; more particularly, of having been treated as a doll or automaton or as an appendage to the parents rather than as a person with a separate existence. The fear has much in common with Freud's "castration anxiety," in the sense of being deprived of potency or effectiveness.

In my own case it's interesting to note that my mother had been a socially-isolated child who devoted a lot of energy to playing with dolls and making clothes for the dolls. In early adulthood my mother applied her self-taught seamstress skills to her employment in a lampshade factory. Later, my mother used to sew much of my sister's wardrobe, which was professional in quality. With regard to disparities between my development and that of my sister, note that being treated like a passive doll is somewhat ego-syntonic for a girl but destructive of a boy's emergent gender identity.

There is a Pygmalion-like quality to Dr. Bash's interaction with me, as if I were a doll to be positioned to her satisfaction, or a block of marble to be sculpted according to her conventionalized expectations. The psychoanalyst Margaret Brenman-Gibson writes: "It is probable that the original Pygmalion story and its derivatives are all statements of the artist and his 'creation.' In a painting, "Pygmalion," at the Metropolitan Museum of Art, the male is embracing the 'female,' whose body is in fact that of a young boy -- broad-shouldered and muscular, clearly another edition of the Narcissus story, with more sublimation [--in psychoanalytic terms, suggesting both the issues of gender-identity as well as narcissistic disturbance]. Clifford Odets: American Playwright (New York: Atheneum, 1989) at 677 n. 24.1.

Of additional interest is the fact that Dr. Bash's symptom-focused strategy of addressing my social isolation to the exclusion of my needs and feelings in general parallels a pedagogic technique that is employed by the parents of some narcissistically-disturbed patients.

The psychoanalyst Phyllis Beren writes: "[Precocious ego development] can be observed in the extreme unevenness of development, where certain capacities and functions may be highly matured or overdeveloped while others lag behind. This uneven development usually dovetails with the parents' inability to see the child as a whole in a developmentally appropriate way, and with their overemphasis on certain of the child's functions that fit in with their own narcissistic needs.

For example, the parents may give a good deal of praise and encouragement for independence, at the expense of emotional and physical closeness. Thus the child discovers that the parents will not accept his dependence, and learns early on to take care of himself. Or the parent may overvalue one particular ego function such as speech, so that speech becomes overvalued and used for defensive purposes rather than for communicative or thought clarifying purposes (citation omitted). What happens to these children is that they tend to use intellectualization and become emotionally removed and aloof. Another outcome may be the child who functions emotionally and physically as a little parent in the family, i.e., when there is an extreme form of role reversal in the parent-child relationship (citation omitted)." Beren, P. "Narcissistic Disorders in Children." In: The Psychoanalytic Study of the Child. Vol. 47: 265-278 at 276 (New Haven: Yale University Press, 1992).

Dr. Bash is unable to see me as a whole, and overemphasizes certain of my functions -- namely my social relations -- that fit in with her own narcissistic needs. I, in turn, experience Dr. Bash as self-serving and authoritarian, rigidly denying my right to express my total personality through the disclosure of my thoughts, feelings, and opinions about myself and my environment. She has turned the joy of human relations into a duty, which, in my analysis confirms that for Dr. Bash "Other People" are an uninternalized parental derivative; they serve as a preautonomous superego that guarantees Dr. Bash's own narcissistic integrity: that satisfies her own narcissistic needs. The psychoanalytically-sophisticated reader will see the relationship between (1) Dr. Bash's moral sleaziness ("As long as the authorities don't know, what's the difference?" -- "You could have gone back to the library after three months, Brian wouldn't have known." -- "Don't tell an employer you're disabled, he doesn't have to know") and (2) Dr. Bash's overemphasis on the need to establish peer relations (presumably, as she sees it, as a guarantor of narcissistic integrity).

Anthony Storr continues: The importance of being unable to influence authority has been vividly depicted by the novelist Kafka in his classic novels "The Trial" and "The Castle." According to Kafka's biographer, Max Brod, Kafka continued throughout his life, to attribute almost magical powers to his father. When he was 36 he wrote a long "Letter to my Father" in which he exposed his continuing sense of inadequacy and his feelings of always being in the wrong which he experienced in relation to his father. The same sense of powerlessness is evident in Kafka's religious attitude. There is an Absolute, but so remote from the life of man that misunderstanding and lack of comprehension is inevitable. Kafka considered that parents were tyrants and slave-drivers. He agreed with Swift that "parents are the least of all to be trusted with the education of their children." His novels are concerned with authorities who are so arbitrary and unpredictable that it was impossible to understand them or work out ways of dealing with them.

An examination of Kafka's social adjustment highlights the limitations or inadequacies of Dr. Bash's recommendation that I "go to the synagogue to make friends." Kafka, though socially-isolated, had a few close friends who adored him. Yet, he never overcame his sense of unease even in the presence of those very friends (and much less, in the presence of strangers -- [see below]) and the social life he did enjoy never permitted him to overcome an ever-present inner despair. Throughout adulthood he reported that he was ravaged by tormenting dreams and daytime dreads. It was only at his writing table that he felt secure.

In a letter dated June 1913, Kafka wrote: "But if I am in an unfamiliar place, among a number of strange people, or people whom I feel to be strangers, then the whole room presses on my chest and I am unable to move, my whole personality seems virtually to get under their skins, and everything becomes hopeless." Storr, A. "Solitude: A Return to the Self," at 101 (New York, The Free Press, 1988).

Neurotic symptoms, says Dr. Storr, are exaggerations of anxieties we all feel. Those who are fortunate enough to possess basic trust in other human beings may find it difficult to empathize with schizoid people because they cannot detect any trace of similar traits in their own personalities. However, even the most "normal" people fear revealing intimate secrets to others; for they realize that to do so is to put oneself in the power of the other person. Real intimacy is not lightly embarked on even by those who are not habitually suspicious. The common fear of getting married is often rooted in the idea that to do so might threaten autonomy to a dangerous extent. Many people who pass for normal are unable to conceive of a human relationship in which the partners are on equal terms, in which giving and taking are reciprocal, and may feel that they themselves have nothing much to give.

Dr. Storr concludes: A third reason for avoiding intimacy is the subject's fear that he will harm or destroy the person to whom he becomes attached. See also Friedman, M. "Survivor Guilt and the Pathogenesis of Anorexia Nervosa." Psychiatry (1985). At first sight this kind of fear may seem to contradict the other varieties since it seems to imply that the subject is more, not less, powerful than the other person. However, the power concerned is of a kind possessed by every child; the power to exhaust or empty the parent. Kleinian analysts would trace such a fear to fantasies arising in the earliest months of life, when a frustrated or greedy infant might suppose that his urgent need had emptied or destroyed the breast upon which his existence depended. However this may be, there is little doubt that older children may come to feel that their capacity to exhaust a parent outweighs the pleasure which the parent may take in their presence, especially if the parent is elderly or ailing.

On several occasions, Dr. Bash has referred to her physical ailments. Twice she has referred to her heart condition, which makes her seem especially vulnerable. These personal comments by a therapist about her physical infirmities are inappropriate; they are antitherapeutic for the patient.
Perhaps it is my distortion, but I read behind the lines of Dr. Bash's medical confessions the statement: "You see how I suffer for you?" or perhaps, "You are killing me." [Cf. Brian Brown to the Metro DC Police: "Officer, I think Mr. Freedman might be dangerous."] In short, Dr. Bash's comments are guilt-inducing for the patient.

According to Dr. Storr, schizoid adults habitually find that relations with others exhaust them, and so suppose that they themselves must be equally exhausting. This leads to a kind of careful watchfulness which makes spontaneity in human relationships impossible. In some instances, this attitude can be traced to the behavior of a parent who is also schizoid [or inattentive to the child's emotional needs]. Small children are to some extent exhausting to most parents in our culture because their care requires constant vigilance and because they cannot provide the kind of interchange on equal terms which adults find rewarding.

Dr. Bash's depiction of my reasonable expectations of psychotherapy as extravagant (namely, that psychotherapy should be a specialized, uniquely-intimate, and emotionally-corrective relationship) seems to hint at the issue of parental depletion. She seems to be saying that my expectation that she offer something more than mere recommendations that I "rely on the kindness of strangers" is inappropriate. Cf. Friedman, M. "Survivor Guilt and the Pathogenesis of Anorexia Nervosa." Psychiatry (1985) ("depletion guilt" is a form of guilt, derived from disturbed parental attitudes, characterized by the child's belief that the gratification of his normal, phase-appropriate needs is destructive to the parents).

Dr. Bash depicts my need that she do more than just make recommendations that I interact with people as an inappropriate imposition on her, and, suggestively (and significantly), uses oral imagery to illustrate her point: "You want everything on a silver platter." Reprise: "A person who suffers from schizoid personality disorder is not simply socially isolated. He has a distinct psychiatric syndrome -- an intrapsychic disturbance -- which impairs his ability to form relationships. Dr. Bash's weekly recommendation (repeated to the point of coercion) is: "Go to the synagogue, go to the synagogue. [Rely on the kindness of strangers!] You didn't go to the synagogue. If you went to the synagogue, you would meet people and make friends." -- "Isn't there anything we can do here, Dr. Bash, to help me?" -- "YOUR PROBLEM IS YOU WANT EVERYTHING ON A SILVER PLATTER. YOU WANT ME TO DO EVERYTHING. (Read: 'I take responsibility for nothing.')"

Dr. Storr adds: There are many parents who feel all too easily drained by their children because they themselves cannot play or enter into a child's world through their imagination.

Dr. Storr's observation about a parent's inability to enter into the child's world parallels an observation I made in an earlier letter to you, the one dated June 28, 2004 that outlines the underlying reasons for my obsession with you:



Subject's mother, though overprotective, was largely uninvolved and uninterested in subject's play or other activities. Mother interacted with subject, but in her own way and on her own terms; she was unwilling or incapable of immersing herself in or participating in her child's own world.
It is telling that in the first grade, subject's teacher summoned the mother to school to admonish her to help subject with his homework and to read to him. Subject's mother had never read to her son. Subject's mother used to say unashamedly: "I hate books!" It is interesting that as an adult, subject's interests and outlook do not match those of his mother; in terms of interests and outlook it is as if subject developed independently from his mother, though he was emotionally dependent on her.

Subject's activity in adulthood of visiting the library and sharing physical space with the uninvolved library manager, while at the same time covertly wooing the manager with undelivered letters, may be a derivative of his early interaction with an uninterested and uninvolved mother who ignored her toddler son's secret entreaties for attention.


The rapprochement subphase (usually between fifteen months and eighteen months) is ushered in by the toddler's dawning realization that the mother is actually a separate person, one who will not always be available to help him in dealing with his newly enlarged world. Mother must now be approached on a new, higher level of interaction, characterized especially by sharing new discoveries in the "outside" world and by language. The early months of the rapprochement subphase are typified by "wooing" behavior of the child toward his mother, in which he tries to obtain her participation in his world within the context of some recognition of his separateness. Greenberg, J.R. and Mitchell, S.A. Object Relations in Psychoanalytic Theory. (Cambridge: Harvard University Press, 1983).

Finally, says Anthony Storr, a child may thus be faced with a parent who not only does not give him the affection and understanding which he desperately needs, but also conveys to him that his needs are potentially destructive of the person to whom he turns to fulfill them. This may lead to the conviction that fulfillment through love is unattainable except in fantasy. Close relationships are regarded as mutually exhausting rather than mutually rewarding; and so the safest thing is to avoid them as far as possible. So says Anthony Storr.

Significantly, Dr. Storr's first point (about the importance of object loss) and his third point (about the child's fear of destroying the object) are both found in a quote (a single sentence, in fact) from an earlier letter I wrote to you, Brian. "Pathological mourning and schizoid detachment are the consequences of early and severe loss; the ensuing withdrawal from all relationships due to ANXIETY OVER FUTURE LOSS (Dr. Storr's first point) and GUILT OVER PERCEIVED DESTRUCTION OF THE OBJECT (Dr. Storr's third point) results in further frustration of emotional needs and dissociated lack of awareness of needs." Ducey, C. "The Life History and Creative Psychopathology of the Shaman." The Psychoanalytic Study of Society. Volume 7: 173-230 at 185 (New Haven: Yale University Press, 1976). Gertrude R. Ticho, MD, contributing editor.

Check you out next week, buddy. Keep your eye out for those falling apples. There's no protection from falling applies.

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